A study conducted at Veterans Affairs medical centers in New England suggests that prostate cancer screening using the prostate-specific antigen (PSA) test or digital rectal exam has no effect on survival. These results were published in the Archives of Internal Medicine.
In 2005 the American Cancer Society estimated that 232,000 men in the U.S. would be diagnosed with prostate cancer, and over 30,000 would die of the disease. Prostate cancer is second only to lung cancer as a leading cause of cancer death in men.
In the U.S., men 50 years or older are often offered PSA testing for the early detection of prostate cancer. The PSA test measures proteins that are produced and shed by the prostate. PSA levels are generally elevated when prostate cancer is present, but levels can also be elevated in benign (non-cancerous) conditions affecting the prostate.
Digital rectal exam (DRE) is also commonly used for prostate cancer screening. During a DRE, a physician inserts a gloved finger into the rectum to assess the texture and size of the prostate. While both PSA testing and DRE have been widely used for the early detection of prostate cancer, it’s been uncertain whether use of these tests improves survival.
To evaluate the effect of PSA and DRE screening on survival, researchers conducted a study at 10 Veterans Affairs Medical Centers in New England. The study enrolled 501 men who had been diagnosed with prostate cancer between 1989 and 1990 and had died of any cause between 1991 and 1999 (cases). These men were compated to 501 men of a similar age who did not die (controls).
The researchers assessed whether history of PSA testing and DRE differed between the study groups. If PSA testing and DRE were more common in the controls (who were alive) than in the cases (who had died), it would suggest that PSA testing and DRE had a beneficial effect on survival.
The results indicate a similar rate of screening in cases and controls, suggesting that screening did not improve survival:
- 14% of cases had been screened with PSA, compared to 13% of controls.
- The similarity in screening history persisted after accounting for race and other serious health conditions.
- A secondary analysis assessed death from prostate cancer only. In this analysis, cases and controls again had a similar history of PSA testing and DRE.
The researchers conclude, “These results do not suggest that screening with PSA or DRE is effective in reducing mortality.” Men who are considering being screened for prostate cancer may wish to talk with their doctor about the risks and potential benefits.
Reference: Concato J, Wells CK, Horwitz RI et al. The Effectiveness of Screening for Prostate Cancer: A Nested Case-Control Study. Archives of Internal Medicine . 2006;166:38-43.
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